Provider Demographics
NPI:1740173608
Name:MILLER, ANGELLE MARIE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELLE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3296 E WILLOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5477
Mailing Address - Country:US
Mailing Address - Phone:225-270-9975
Mailing Address - Fax:
Practice Address - Street 1:291 S 200 W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2419
Practice Address - Country:US
Practice Address - Phone:225-270-9975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14195862-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health